ICD-10 Coding for Glenohumeral Osteoarthritis(M19.011, M19.012)
Complete ICD-10-CM coding and documentation guide for Glenohumeral Osteoarthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Glenohumeral Osteoarthritis
M19.01-M19.02Primary Range
Primary osteoarthritis of the shoulder
This range includes specific codes for primary osteoarthritis affecting the right and left shoulder, which are crucial for accurate diagnosis and treatment documentation.
Post-traumatic osteoarthritis of the shoulder
This range is used when osteoarthritis is secondary to a previous injury, requiring documentation of the trauma history.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M19.011 | Primary osteoarthritis, right shoulder | Use when primary osteoarthritis is confirmed in the right shoulder with no underlying cause. |
|
| M19.012 | Primary osteoarthritis, left shoulder | Use when primary osteoarthritis is confirmed in the left shoulder with no underlying cause. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for glenohumeral osteoarthritis
Essential facts and insights about Glenohumeral Osteoarthritis
Primary ICD-10-CM Codes for glenohumeral osteoarthritis
Decision Criteria
clinical Criteria
- Confirmed primary osteoarthritis with imaging
documentation Criteria
- Detailed history and physical exam findings
Applicable To
- Degenerative joint disease of the right shoulder
Excludes
- Post-traumatic osteoarthritis (M19.111)
Clinical Validation Requirements
- Radiographic evidence of joint space narrowing
- Presence of osteophytes
- Subchondral sclerosis
Code-Specific Risks
- Incorrect laterality documentation
- Missing imaging evidence
Coding Notes
- Ensure laterality is documented clearly to avoid coding errors.
M19.012 - Primary osteoarthritis, left shoulder
Use when primary osteoarthritis is confirmed in the left shoulder with no underlying cause.
Applicable To
- Degenerative joint disease of the left shoulder
Excludes
- Post-traumatic osteoarthritis (M19.112)
Clinical Validation Requirements
- Radiographic evidence of joint space narrowing
- Presence of osteophytes
- Subchondral sclerosis
Coding Notes
Ensure laterality is documented clearly to avoid coding errors.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Glenohumeral Osteoarthritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M19.011.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Attach imaging reports to the patient's record, Ensure imaging findings are referenced in the diagnosis
Impact
Reimbursement: Incorrect coding can lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines may result in audits., Data Quality: Impacts the accuracy of patient records and data analysis.
Mitigation Strategy
Verify and document the affected shoulder clearly in the medical record.
Impact
Failure to document laterality can lead to incorrect coding and audits.
Mitigation Strategy
Implement a checklist to ensure laterality is documented in all relevant notes.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Glenohumeral Osteoarthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Glenohumeral Osteoarthritis
Use these documentation templates to ensure complete and accurate documentation for Glenohumeral Osteoarthritis. These templates include all required elements for proper coding and billing.
Orthopedic evaluation for shoulder osteoarthritis
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Diagnosis and treatment plan
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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